June 2006
Erik Nord
Norwegian Institute of Public Health
Parlty annotated bibliography of work published in
English
Doctoral
thesis:
Nord E. Efficiency
and priority setting. Some problems in cost-effectiveness analysis of health care.
Thesis defended at the Department of Political Science,
Nord E. Cost-value analysis in health care: Making
sense out of QALYs.
Text book in which I summarise my previous
work, offer an updated review of empirical studies of preferences for resource
allocation in health care and suggest an alternative to the conventional QALY
model, in which population preferences are measured by means of the person
trade-off technique.
Articles:
1. Nord E, Vale PH.
Policies to reduce the consumption of fat in milk. Health Promotion
1989;4:277-280.
Complete
replacement of full-cream milk by low-fat milk in
2. Nord E, Dahl E.
Socioeconomic status and the use of public hospitals in
Data on
morbidity and admission ratios do not support a hypothesis that social
discrimination violating the need principle occurs to any important extent in Norwegian
hospital practice.
3. Nord E.
Expenditures on health care in the last year of life. Int J Health Planning and
Management 1989;4:319-322.
18-26 % of
public expenditure on health care in
4. Nord E. The
significance of contextual factors in valuing health states. Health Policy
1989;13:189-198.
Several
contextual factors may affect the social value assigned to a health improvement
in a particular patient- year. The factors are set together in a model that may
serve as a framework within which simple QALY calculations may be considered.
5. Nord E. A comment
on the meaning of numerical valuations of health states. Soc Sci Med
1990;30:943-944.
While
numbers for quality of life may appear meaningless, numerical expressions of
strength of preference for different outcomes are not.
6. Nord E. Reducing
sick leave costs by shortening waiting periods for elective surgery. Med Decis
Making 1990;10:95-101.
Empirical
studies suggest that reductions in sick leave costs may exceed the marginal
costs of reducing waiting times.
7. Nord E. The
validity of a visual analogue scale in
determining social
utility weights for health states. Int J Health Planning and Management
1991;6:234-42.
2. Intervals
between states on the EuroQol VAS must be weighted more the closer they are to
the bottom of the scale.
8. Nord E. EuroQol:
Health-related quality of life measurement. Valuations of health states by the
general public in
1. An
experiment with an alternative lay out of the EuroQol instrument added little
to its feasibility.
2.
Valuations in a random sample of Norwegian subjects were quite similar to
valuations made by subjects in
9. Nord E. Methods
for quality adjustment of life years. Soc Sci & Med 1992;34:559-69.
3. Quality
weights for life years are empirically more meaningful, in the sense that they
are more amenable to empirical testing, if they are interpreted simply as
preference weights rather than measures of amounts of well life in the
utilitarian tradition.
10. Nord E. The use
of EuroQol values in QALY calculations. In: Bjørk S (red.). EuroQol Conference
Proceedings. IHE working paper 1992:2.
Using
Norwegian preference data, a transformation function for EuroQol values is
suggested for use in calculation of QALYs in health program evaluation.
11. Iversen T, Nord
E. Priorities among waiting list patients. In Zweifel P, Frech III HE (eds).
Health Economics Worldswide, 203-216. Kluwer Academic Publishers, 1992.
Consultants'
stated criteria for prioritising were compared with actual criteria as revealed
by data on waiting times for patients with different attributes. There was good
correspondence for the variable "strong pain", a weaker
correspondence for "on sick leave" and otherwise no statistically
significant correspondence.
12. Nord E. An
alternative to QALYs: The Saved Young Life Equivalent (SAVE). Br Med J
1992;305:875-877.
Society's
appreciation of one particular health care outcome - saving a young life - is
suggested as a unit of value. Other health care outcomes may be valued directly
in terms of SAVEs by means of a simple equivalence of numbers technique.
13. Nord E. The
relevance of health state after treatment in prioritising between patients. J
Med Ethics 1993;19:37-42.
In
QALY-thinking, an activity that takes N people from a bad state to the state of
health for X years should have priority over an activity that takes N other
people from the same bad state to a state of moderate illness for the same
number of years (given equal costs). However, an empirical study indicates that
Norwegians tend to emphasize equality in value of life and in entitlement to
treatment rather than level of health after treatment.
14. Nord E. Towards
quality assurance in QALY-calculations. Int J Techn Assess Health Care
1993;9:37-45.
1. The
utility weights that were used in 15 published scientific articles mostly had a
weak theoretical and empirical basis.
2. Readers
were generally not provided with information that would allow independent
calculations based on different choices of utility weights.
15. Nord E.
Unjustified use of the Quality of Well-Being Scale in
The QWB does
not have the cardinal properties that are required in calculations of social
benefit. A set of health state values based on upper end compression would have
produced a priority list more in accordance with public preferences than the
one based on the QWB issued by the Oregon Health Services Commission in May
1990.
16. Nord E,
Richardson J, Macarounas-Kirchmann K. Social evaluation of health care versus
personal evaluation of health states: Evidence on the validity of four health
state scaling instruments using Norwegian and Australian surveys. Int J Techn
Assess Health Care 1993;9:463-478.
Public
preferences as measured in terms of person trade-offs suggest that the McMaster
Health Classification System and the EuroQol Instrument assign excessively low
values to health states. The Quality of Well-Being Scale appears to compress
states towards the middle of the 0-1 scale. The Rosser/Kind index fits
reasonably well with directly measured person trade-off data.
17. Nord E. The
trade-off between severity of illness and treatment effect in cost-value
analysis of health care. Health Policy 1993;24:227-238.
Cfr. paper
no 12 above. Social appreciation of health care programs is a function of the
severity of the patients' initial state as well as of treatment effect.
Prioritising on the basis of cost per QALY misses the former point. A pilot
study suggests that the trade-off between severity and effect - both measured
on the same 7-point scale - can be modeled mathematically with reasonable
accuracy. The social value of any outcome in terms of SAVEs may then be
expressed as a function of severity and effect. Cost per SAVE may be useful as
a guiding criterion in prioritising.
18. Wannag A, Nord E.
Work content of Norwegian occupational physicians. Scand J Work Environ Health
1993;19:394-398.
The work of
50 randomly selected occupational physicians on 249 work days was recorded in
detail and assigned to nine different categories. 22 % of the recorded time was
spent on non work related illnesses.
19. Nord E. The QALY
- a measure of social value rather than individual utility. Health Economics
1994;3:89-93.
The QALY
interpreted as a measure of amounts of well life does not carry sufficient
empirical meaning. As a measure of individuals' personal appreciation of
outcomes in their own lives the QALY does not work in comparisons of life
saving interventions with interventions that improve health or increase life
expectancy. QALYs need to be interpreted as a measure of social value, and this
requires use of the person trade-off technique for eliciting social
preferences.
20. Nord E. The role of
cost-effectiveness analysis in resource allocation in health care. In:
Productividad, cobertura y calidad. Ministry of Health, Santiago de Chile,
1994.
There may be
much productivity to be gained from applying better benefit measures in
describing hospital outcomes and from applying cost-effectiveness analysis to
decision making at the budget level. Such steps towards monitoring and
increasing productivity ought not to be too hard for doctors to accept. On the
other hand, health authorities may have to accept that CEA should continue to
play a limited role in doctors' prioritising between individual patients.
21. Nord E. Outcome
measures for resource allocation decisions in health care. In Albrecht G,
Fitzpatrick R (eds). Advances in medical sociology, vol 5.
The article
is based on no 19 and no 17.
22. Nord E. The
person trade-off approach to valuing health care programs. Medical Decision Making 1995,15, 201-208.
The Person
trade-off approach (PTO) establishes the number of patients treated in one
program that people consider equal in social value to a given number of
patients in another program. The approach is theoretically the most valid one
for valuing different health care programs. The PTO needs to be applied in
fairly large groups to keep random measurement error at an acceptable level.
Possible framing effects include the effects of argument presentation, the
choice of start points in numerical exercises and the choice of decision
context.
23. Nord E. The use
of cost-value analysis to judge patients' right to treatment. The International
Journal of Medicine and Law 1995, 14,553-558.
See 17. The
question is raised whether a value table for health outcomes may be helpful in
judging patients' lawful right to treatment.
24. Nord E,
Richardson J, Street A, Kuhse H, Singer P. Maximizing health benefits versus
egalitarianism: An Australian survey of health issues. Social Science &
Medicine 1995,41,1429-1437.
Economists
have often treated the objective of health services as being the maximisation
of the QALYs gained, irrespective of how the gains are distributed. In a cross
section of Australians such a policy received very little support when the
consequence is a loss of equity and access to services for the elderly and for
people with a limited potential for improving their health.
25. Nord E,
Richardson J, Street A, Kuhse H, Singer P. Who cares about cost? Does economic
analysis impose or reflect social values? Health Policy 1995,34,79-94.
In a cross
section of Australians, respondents generally felt that it is unfair to
discriminate against patients who happen to have a high cost illness and that
costs should therefore not be a major factor in prioritising. The majority
maintained this view even when confronted with its implications in terms of the
total number of people who could be treated and their own chance of receiving
treatment if they fall ill.
26. Nord E,
Richardson J, Street A, Kuhse H, Singer P. The significance of age and duration
of effect in social evaluation of health care. Health Care Analysis
1996,4,103-111.
A study
using the person trade-off technique in a cross section of Australians shows
support for the assumptions in the QALY approach that duration of benefits, and
hence also age, should count in prioritising at the budget level in health
care.
27. Nord E. Health
status index models for use in resource allocation decisions: A critical review
in the light of observed preferences for social choice. The International Journal
of Technology Assessment in Health Care, 1996,12,3.
Multiattribute
health status index models are markeded as aids in calculating QALYs in health
program evaluation. The models can be tested by comparing their implications
with direct observations of how societies think resources should be distributed
across patient groups. The paper reviews empirical evidence of this kind from
various countries and summarises the
evidence in three rules of thumb for selecting values for health states. Eight
different models (QWB, HUI 1&2, EuroQol, IHQL simple & complex, 15-D,
Rosser/Kind-index) are judged relative to these rules of thumb. Seven of the
models underestimate the strength of social preferences for treating the
severely ill before the less severely ill.
28. Eriksen BO, Almdahl SM, Hensrud A, Jæger S,
Kristiansen IS, Murer FA, Nord E et al. Assessing
health benefit from hospitalization: Agreement between expert panels. Int J of
Techn Assess in Health Care 1996,12,126-135.
Agreement
between two expert panels in assessing gain in life expectancy and quality of
life gain from unselected stays in a department of internal medicine was
investigated. Weighted kappas of 0.45-0.63 were found.
29. Brook R, with the
EuroQol Group. EuroQol: The current state of play. Health Policy 1996, 37,
53-72.
A review of
methodological issues addressed in the development of the EuroQol Instrument.
30. Magnus P, Stigum
H, Nord E et al. Quality adjusted life years in planning preventive measures.
Journal of the Norwegian Medical Association 1996,116,1229-1232. (Abstract in
English).
Cost-per-QALY
was calculated for testing blood donors for HTLV I/II.
31. Nord E. A table
of values for cost-effectiveness analysis in health care. Journal of the
Norwegian Medical Association 1996, 116, 3246-3249. (Abstract in English).
Further
development of paper 17 above.
32. Nord E, Badia X,
Rue M, Sintonen H. Hypothetical valuations of health states versus patients'
self ratings. In Badia et al (eds).
EuroQol Plenary Meeting,
The values
that patients assign to their own health state tend to be higher than the
values that healthy people assign to those same states on a hypothetical basis.
33.
The concern
for equity comes out more strongly when preferences for resource allocation are
elicited from subjects who respond out of self-interest from behind a veil of
ignorance.
34. Nord E. Comment:
Aggregating health state valuations. Journal of Health Services Research and
Policy 1997, 2, 166-167.
A medians based EuroQol tariff performs
better than a means based one in predicting societal person trade-off
preferences because of its greater degree of upper end compression of health
state values.
35. Nord E, Wisløff
F, Hjorth M, Westin J. Cost-utility analysis of melphalan plus prednisone with
or without interferon alpha 2B in newly diagnosed multiple myeloma.
Pharmacoeconomics 1997,12, 89-103.
Adding
interferon alpha 2B can at most be justifiable in terms of cost-effectiveness
in subgroups with high treatment response.
36. Nord E. A review
of synthetic health indicators.
Background paper
prepared for the OECD Directorate for
Education,
Employment, Labour and Social Affairs.
Mimeo, 43 pages. June
1997.
Gives a
detailed description of existing multi-attribute utility instruments and
assesses their reliability and validity.
37. Eriksen BO, Kristiansen IS, Nord E et al. Does admission
to a medical department improve patient life
expectancy.
Journal
of Clinical Epidemiology 1997, 50, 987-995.
The majority
of admitted patients did not gain life expectancy, but a minority had
substantial gains.
38.
Hofoss D, Nord E. Norwegian doctors – affluent and
reputed,
but not particularly contented. J Norw Med Ass
1997,117, 3476-81. (Abstract in English.)
Norwegian
doctors enjoy a high standard of living but score lower than a population
reference group on quality of life indicators. Stress at work is a likely
explanation.
39.
Neymark N, Kiebert W, .. Nord E, et al. Methodological
and
statistical issues of quality of life and economic
evaluation
in cancer clinical trials: Report of a workshop.
European
Journal of Cancer 1998,34,1317-1333.
Gives a
general discussion of a number of issues.
40. Eriksen BO, Kristiansen IS, Nord E et al. Does admission
to a department of medicine improve patients’
quality of life?
Journal of Internal Medicine 1998,244,397-404.
A department
of medicine was effective in improving the QoL in 81 % of the admitted
patients.
41.
Nord E, Pinto JL,
Incorporating
societal concerns for fairness in numerical
Valuations
of health programs. Health Economics 1999,8,25-39.
Shows
how the conventional QALY model can be modified so as to include equity weights
that account for societal concerns for giving priority to the severely ill over
the less severely ill and not discriminating too strongly between patients with
different potentials for health.
42.
Nord E, Wolfson M. Multi-attribute health state valuations: Ambiguities in
meaning. Quality of life Newsletter 21/1999.
instruments place quite different meanings on the numbers
they offer, and evidence of the meanings that are claimed is poor. The
situation is confusing to potential users.
43.
Menzel P, Gold M, Nord E et al. Toward a broader view of values in
cost-effectiveness analysis of health.
A wider
ethical discussion of the issues addressed in no 39 and some related issues.
44. Nord E. Towards cost-value analysis in
health care? Health Care Analysis, 1999, 7, 167-175.
Summarises 41 and 43 and
presents a table of person
trade-off
based values for health states that could replace conventional utilities in
cost-effectiveness analysis.
45. Kristiansen IS, Kvien TK, Nord E.
Cost-effectiveness of replacing diclofenac with a fixed combination of
misoprostol and diclofenac in patients with rheumatoid arthritis. Arthritis
& Rheumatism 1999,42.
Replacing
diclofenac with a fixed diclofenac/misoprostol
combination
is cost-effective when restricted to RA
patients
at increased risk of serious gastro-intestinal
events.
46. Nord E. Adjusting health state utilities
for use in economic evaluation. Quality of life Newsletter 23/1999.
Offers
a diagram for transforming utilities from multi-
attribute
utility instruments into numbers that
encapsulate
concerns for fairness and therefore can be
used
to estimate the societal value of health programs.
47. Arnesen T, Nord E. The value of DALY life:
problems with ethics and validity of disability adjusted life years. Br Med
Journal 1999, 319, 1423-1425.
The
version of the person trade-off technique used in the Global Burden of Disease Report in 1996 was found to be
unethical
and incomprehensible and was rejected by a
team
of European researchers. An alternative version was
developed.
48. Nord E. My goodness – and yours. A history,
and some possible futures, of DALY meanings and valuation procedures.
Paper for WHO’s Global Conference on Summary
Measures of Population Health, Marrakech December 1999. Mimeo, 9 pages. In
press (2002) in Proceedings from the conference.
Discusses
ways of establishing disability weights
depending
on whether DALYs are supposed to measure health
in
a narrow sense or also capture concerns for severity.
49. Wisløff F, Gulbrandsen N, Nord E.
Therpeutic options in treatment of multiple myeloma. Pharmacoeconomics 1999,4,
329-341.
Review.
50. Nord E. Summary of survey about health
economics in
There
is high interest, moderate knowledge and little use
of
other techniques than monetary cost-benefit analysis.
51. Eriksen BO, Førde OH,
Kristiansen IS, Nord E et al. Cost
savings and health losses from reducing inappropriate admissions to a
department of internal medicine. Int J Techn Assessment in Health Care 2000,18,
1143-1153.
Savings
obtained by excluding admissions predicted to be
inappropriate
were small relative to the health losses
(due
to lack of specificity in ex ante judgments).
52. Stigum H, Magnus P, Samdal HH, Nord E.
Human T-cell lymphotropic virus testing of blood donors in
53. Ubel P, Nord E et al. Improving value
measurement in cost-effectiveness-analysis. Medical Care 2000,38,892-901.
54. Nord E, Arnesen T, Menzel P, Pinto JL. Towards
a more restricted use of the term ’quality of life’. Quality of Life Newsletter
2001/26.
55. Nord E. Health state values for
multiattribute utility instruments need correction. Ann Med 2001,33,371-374.
56. Nord E. The desirability of a condition
versus the well being and worth of a person. Health Economics 2001,10,579-581.
57. Nord E. Severity of illness versus expected
benefit in societal evaluation of health care interventions. Expert Rev
Pharmacoeconomics Outcomes Res 2001,1,85-92.
58. Gulbrandsen N, Wisløff F, Nord E et al.
Cost-utility analysis of high dose melphalan with autologous blood stem cell
support. Eur J Haematol 2001,66,328-336.
59. Nord E. Measures of goal attainment and
performance in the World Health Report
Health Policy 2002,59,183-191.
59b. Nord
60. Nord E. Comments to ’A note on cost-value
analysis’. Health Economics 2003,12,251-253.
61. Nord E. Fairness in evaluating health
systems. In Proceedings from WHO 1999 Conference in
63. Schwarzinger M, Lanoë J-L, Nord E,
Durand-Zaleski I. Lack of multiplicative transitivity in person trade-off
responses. Health Economics, 2004,13,171-181.
64. Nord E, Menzel P, Richardson J. The value
of life: Individual preferences and social choice. A comment to Magnus
Johannesson. Health Economics,2003,12,873-877.
65. Nord E. The usefulness of formal outcome
evaluations in health policy making: Looking for the baby in the bathwater.
In: ter Meulen R et al
(eds). Evidence-based practice
in medicine and health care. Springer Verlag 2005.
66 Pinto JL, Nord E. Incorporating concerns for
fairness in economic evaluation of health programs. Humanitas 2003 (text in
Spanish).
69 Nord E. Some ethical corrections to valuing health
programs in terms of quality adjusted life years (QALYs). Virtual
70 Nord E. Values for health in QALYs and DALYs:
Desirability versus well-being and worth. In Wasserman D et al (eds). Quality
of life and human difference.
71 Nord E. Coping with depression. J Norw Med Association 2005. (Helseøkonomisk
vurdering av kurs i mestring av depresjon). Text in Norwegian.
72 Nord E, Menzel P, Richardson J. Multi-method
approach to valuing health states: Problems with meaning. Health Economics
2006,15,215-218.
73 Nord E. Severity of illness and priority setting:
Lack of discussion of surprising finding. Journal of Health Economics
2006,25,170-172.
74 Nord E. Utilitarian Decision Analysis of
Informed Consent. Am J Bioethics 2006,6, May/June.